Season 7 - Episode 50 - #TerryTuesday - Independence and Objectivity in Auditing!

The Compliance Guy

Summary

In this conversation, Sean and Terry discuss the critical importance of conducting audits in healthcare practices, emphasizing the need for both internal and external reviews to ensure compliance and accuracy in coding and billing. They highlight real-world examples of practices that have suffered due to a lack of audits and the biases that can occur in internal reviews. The discussion also touches on the role of compliance in healthcare and the upcoming topic of prior authorizations.

Takeaways

• Many practices have never conducted an audit of their coding and billing.
• Internal audits can be biased and may not capture all issues.
• External audits provide an objective perspective on compliance.
• Providers often make assumptions about documentation that can lead to errors.
• The Department of Justice emphasizes independence in auditing practices.
• Training and education are crucial for coding staff.
• Practices can lose significant revenue due to improper billing.
• Compliance plans should include prior authorization processes.
• Auditing is essential for identifying fraud and ensuring compliance.
• Investing in audits can save practices money in the long run.